Question 2123
{"accessible":false,"alternatives":[{"id":10543,"text":"Le Fort II fracture"},{"id":10544,"text":"Le Fort III fracture"},{"id":10546,"text":"Markowitz and Manson type I naso-orbito-ethmoid fracture"},{"id":10547,"text":"Markowitz and Manson type II naso-orbito-ethmoid fracture"},{"id":10548,"text":"Markowitz and Manson type III naso-orbito-ethmoid fracture"},{"id":10545,"text":"medial orbital wall and floor blowout fractures"}],"archived":false,"correctAlternativeId":10547,"explanation":"\u003cp\u003eThe description is consistent with\u0026nbsp;a naso-orbito-ethmoid (NOE) fracture, which is defined by at least 4 of 5 cardinal fracture lines: (1) lateral nasal bone and pyriform aperture, (2) crossing the medial maxillary buttress, (3) the inferior orbital rim and orbital floor, (4) the medial orbital wall, and (5) the frontomaxillary suture. For management purposes, NOE fractures are most importantly classified as simple or comminuted. Markowitz and Manson type I corresponds to a simple fracture, in which the cardinal tracts outline an intact central fragment to which the medial canthal tendon attaches (at the anterior and posterior edge of the lacrimal fossa). Markowitz and Manson types II and III fractures are comminuted. While definitive differentiation between types II and III is made on intraoperative evaluation, the description here indicated that the central fragment where the medial canthal tendon attaches is intact rather than involved by fracture. Therefore, it likely represents a type II NOE fracture. In contrast, a type III NOE fracture would be classified as such if that central fragment is comminuted and fracture lines involve the medial canthal tendon insertion site, or the tendon was found to be avulsed from the bone.\u003c/p\u003e\u003cp\u003eThe description is inadequate to justify a classification of a Le Fort fracture, which almost always features a fracture of the pterygoid plates. Moreover, the absence of a lateral maxillary sinus wall fracture rules out a Le Fort II pattern and the absence of a lateral orbital wall fracture rules out a\u0026nbsp;Le Fort III pattern.\u003c/p\u003e","id":2123,"imageUrl":null,"imageAttribution":null,"imageAttributionCaseInfo":null,"firstQuestionPath":"/questions/2123","nextQuestionPath":null,"relatedArticles":[{"id":1317,"title":"Le Fort fracture classification","link":"/articles/le-fort-fracture-classification?lang=gb"},{"id":30908,"title":"Naso-orbitoethmoid (NOE) complex fracture","link":"/articles/naso-orbitoethmoid-noe-complex-fracture?lang=gb"},{"id":42077,"title":"Markowitz and Manson classification system of naso-orbitoethmoid fractures","link":"/articles/markowitz-and-manson-classification-system-of-naso-orbitoethmoid-fractures-1?lang=gb"}],"alsoUsedIn":[{"id":986,"kind":"Course","title":"2021 Virtual Conference Private Use - page 986","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/986"},{"id":986,"kind":"Course","title":"Radiopaedia 2021 - isoCME - page 986","link":"https://radiopaedia.org/courses/radiopaedia-2021-isocme/pages/986"},{"id":986,"kind":"Course","title":"2022 Virtual Conference Private Use - page 986","link":"https://radiopaedia.org/courses/2022-virtual-conference-private-use/pages/986"},{"id":970,"kind":"RestrictedPage","title":"Page 970 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/970"},{"id":955,"kind":"RestrictedPage","title":"Page 955 (in no courses)","link":"https://radiopaedia.org/admin/restricted_pages/955"},{"id":1,"kind":"LiveSchedule","title":"1","link":"https://radiopaedia.org/admin/live_schedules/1"},{"id":19,"kind":"LiveSchedule","title":"19","link":"https://radiopaedia.org/admin/live_schedules/19"},{"id":919,"kind":"Course","title":"2021 Virtual Conference Private Use - page 919","link":"https://radiopaedia.org/courses/2021-virtual-conference-private-use/pages/919"},{"id":919,"kind":"Course","title":"Radiopaedia 2021 - isoCME - page 919","link":"https://radiopaedia.org/courses/radiopaedia-2021-isocme/pages/919"},{"id":919,"kind":"Course","title":"Head \u0026 Neck Lectures - page 919","link":"https://radiopaedia.org/courses/head-neck-lectures/pages/919"}],"stem":"\u003cp\u003eA CT report for facial trauma contains the following findings: \"There is a mildly comminuted fracture involving the left frontal process of the maxilla and left nasal bone. Fracture lines in this region\u0026nbsp;extend from the pyriform aperture across the medial maxillary buttress to the left inferior orbital rim, sparing the infraorbital canal. However, minimally displaced fractures involve the medial third of the orbital floor, internal orbital buttress, and the lamina papyracea. There is less than 0.5 mm\u0026nbsp;outward herniation of extraconal\u0026nbsp;fat into the ethmoid labyrinth.\u0026nbsp;One of the fracture lines extends anteriorly to the frontomaxillary suture, liberating a minimally displaced\u0026nbsp;fragment of bone containing the lacrimal fossa, which appears intact. The left lateral orbital wall is intact. There is a fracture of the medial wall of the maxillary sinus but not the lateral wall.\"\u003c/p\u003e\u003cp\u003eWhat\u0026nbsp;classification best summarises the most significant\u0026nbsp;injuries?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2123"}],"attemptsPercentages":[{"alternativeId":"10545","percentage":7},{"alternativeId":"10543","percentage":29},{"alternativeId":"10548","percentage":12},{"alternativeId":"10547","percentage":28},{"alternativeId":"10544","percentage":13},{"alternativeId":"10546","percentage":11}],"promptToLogin":false,"questionManager":false,"articleId":"orbital-blow-out-fracture"}